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Sillanpää M, Saarinen M. Infantile colic associated with childhood migraine: A prospective cohort study. Cephalalgia 2015; 35:1246-51. [DOI: 10.1177/0333102415576225] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 01/18/2015] [Indexed: 11/16/2022]
Abstract
Purpose To explore the association between infantile colic and adolescent migraine. Method In a randomized general population sample, families expecting their first child were prospectively followed for infantile colic and adolescent migraine. Results Colic was diagnosed in 160 (13%) of 1267 infants until the age of 3 months. Migraine was ascertained in 129 (16%) of 787 adolescents at age 18 years. History of infantile colic was identified in 96 (12%) of 787 adolescents and no such history in 658 (88%) of 787 adolescents. Migraine was present in 22 (23%)/96 adolescents who had a history of infantile colic, but in only 74 (11%)/658 ones who had no such history. Of the 22 adolescents, 14 (64%) had migraine without aura and eight (36%) had migraine with aura. Infants with colic had an almost three-fold risk (risk ratio 2.8, 95% confidence interval 1.2–6.5) for adolescent migraine without aura, but no increased risk for migraine with aura (0.8, 0.3–2.2). Discussion and conclusions Infantile colic seems to be associated with an increased risk for migraine without aura, but not for migraine with aura. Whether infantile colic per se is a type of infantile migraine or an antecedent of future migraine remains to be answered by further research.
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Affiliation(s)
- Matti Sillanpää
- Department of Public Health, University of Turku, Finland
- Department of Child Neurology, University of Turku, Finland
| | - Maiju Saarinen
- Department of Public Health, University of Turku, Finland
- Department of Child Neurology, University of Turku, Finland
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Affiliation(s)
- Amy A Gelfand
- UCSF Headache Center, Department of Neurology, University of California San Francisco, USA; Division of Child Neurology, UCSF, USA
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van Tilburg MAL, Hyman PE, Walker L, Rouster A, Palsson OS, Kim SM, Whitehead WE. Prevalence of functional gastrointestinal disorders in infants and toddlers. J Pediatr 2015; 166:684-9. [PMID: 25557967 DOI: 10.1016/j.jpeds.2014.11.039] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 09/18/2014] [Accepted: 11/18/2014] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To determine the prevalence of gastrointestinal symptoms suggestive of an infant/toddler functional gastrointestinal disorder (FGID) as reported by parents in a representative community sample. STUDY DESIGN Mothers (n = 320) of children aged 0-3 years old were recruited in the US and completed a questionnaire about their child's and their own gastrointestinal symptoms. RESULTS By Rome criteria, 27% of infants/toddlers qualified for FGIDs. Infant regurgitation was the most common disorder in infants and functional constipation in toddlers. No age, sex, or race differences were found in FGID diagnoses. Compared with those who did not meet Rome criteria, toddlers with FGID had lower quality of life (M = 80.1 vs M = 90.3, P < .001), increased medical visits (M = 0.38 vs 0.14; P < .05), mental health visits (M = 0.29 vs 0.06; P < .05), and hospital stays (M = 0.35 vs 0.06; P < .01). A child was more likely to suffer from hard stools if the parent also reported hard stools (P = .02), but similar association was not found with loose stools. CONCLUSIONS FGIDs are common in infants and toddlers and can be identified in the general population. They do not vary with sex and race. Quality of life is reduced in those with FGIDs. More research is needed into these largely neglected conditions as it may improve the lives of a significant number of young children.
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Affiliation(s)
- Miranda A L van Tilburg
- Center for Functional GI and Motility Disorders, University of North Carolina, Chapel Hill, NC.
| | - Paul E Hyman
- Department of Pediatrics, Louisiana State University School of Medicine, New Orleans, LA
| | - Lynne Walker
- Division of Adolescent Medicine and Behavioral Science, Vanderbilt University, Nashville, TN
| | - Audra Rouster
- Department of Pediatrics, Louisiana State University School of Medicine, New Orleans, LA
| | - Olafur S Palsson
- Center for Functional GI and Motility Disorders, University of North Carolina, Chapel Hill, NC
| | - Sung Min Kim
- Center for Functional GI and Motility Disorders, University of North Carolina, Chapel Hill, NC
| | - William E Whitehead
- Center for Functional GI and Motility Disorders, University of North Carolina, Chapel Hill, NC
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van Hemert S, Breedveld AC, Rovers JMP, Vermeiden JPW, Witteman BJM, Smits MG, de Roos NM. Migraine associated with gastrointestinal disorders: review of the literature and clinical implications. Front Neurol 2014; 5:241. [PMID: 25484876 PMCID: PMC4240046 DOI: 10.3389/fneur.2014.00241] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 11/06/2014] [Indexed: 12/12/2022] Open
Abstract
Recent studies suggest that migraine may be associated with gastrointestinal (GI) disorders, including irritable bowel syndrome (IBS), inflammatory bowel syndrome, and celiac disease. Here, an overview of the associations between migraine and GI disorders is presented, as well as possible mechanistic links and clinical implications. People who regularly experience GI symptoms have a higher prevalence of headaches, with a stronger association with increasing headache frequency. Children with a mother with a history of migraine are more likely to have infantile colic. Children with migraine are more likely to have experienced infantile colic compared to controls. Several studies demonstrated significant associations between migraine and celiac disease, inflammatory bowel disease, and IBS. Possible underlying mechanisms of migraine and GI diseases could be increased gut permeability and inflammation. Therefore, it would be worthwhile to investigate these mechanisms further in migraine patients. These mechanisms also give a rationale to investigate the effects of the use of pre- and probiotics in migraine patients.
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Affiliation(s)
| | - Anne C Breedveld
- Division of Human Nutrition, Wageningen University , Wageningen , Netherlands
| | - Jörgen M P Rovers
- Department of Neurology, Gelderse Vallei Hospital , Ede , Netherlands
| | | | - Ben J M Witteman
- Department of Gastroenterology and Hepatology, Gelderse Vallei Hospital , Ede , Netherlands
| | - Marcel G Smits
- Department of Neurology, Gelderse Vallei Hospital , Ede , Netherlands
| | - Nicole M de Roos
- Division of Human Nutrition, Wageningen University , Wageningen , Netherlands
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Spiri D, Rinaldi VE, Titomanlio L. Pediatric migraine and episodic syndromes that may be associated with migraine. Ital J Pediatr 2014; 40:92. [PMID: 25928129 PMCID: PMC4239406 DOI: 10.1186/s13052-014-0092-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 11/07/2014] [Indexed: 01/03/2023] Open
Abstract
Importance Migraine is a common disorder and a frequent cause of medical consultation in children. Many childhood episodic syndromes have been described as common precursors of migraine. Objective To review current knowledge on migraine and childhood episodic syndromes, and to discuss future directions for research and clinical practice. Findings For most children it is difficult to describe a headache and fully verbalize symptoms such as photophobia and phonophobia that must be inferred from behaviour. Classical migraine features are rare before the age of 6 years, but some migraine-related syndromes have been described. Benign paroxysmal torticollis of infancy, benign paroxysmal vertigo of childhood, cyclic vomiting syndrome and abdominal migraine are currently classified as childhood episodic syndromes, and therefore common precursors of migraine. A strong association between infantile colic and migraine has recently been reported. There are similarities between children with episodic syndromes and children with migraine, regarding social and demographic factors, precipitating and relieving factors, and accompanying gastrointestinal, neurologic, and vasomotor features. The real pathophysiological mechanisms of migraine are not fully understood. Current data obtained through molecular and functional studies provide a complex model in which vascular and neurologic events cooperate in the pathogenesis of migraine attacks. Genetic factors causing disturbances in neuronal ion channels, make a migraineur more sensitive to multiple trigger factors that activate the nociception cascade. The expanding knowledge on migraine genetics and pathophysiology may be applicable to childhood episodic syndromes. Migraine preventive strategies are particularly important in children, and could be beneficial in childhood episodic syndromes. Nonspecific analgesics like ibuprofen and acetaminophen are widely used in pediatrics to control pain and have been found to be effective also in the treatment of acute migraine attacks. Triptans are the specific fist-line drugs for acute migraine treatment. Conclusions and relevance Migraine phenotype differs somewhat in the developing brain, and childhood episodic syndromes may arise before typical migraine headache. Diagnosing pediatric migraine may be difficult because of children’s language and cognitive abilities. The risk of underestimating migraine in pediatric age is high. An adequate diagnosis is important to maintain a good quality of life and to avoid inappropriate therapy.
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Affiliation(s)
- Daniele Spiri
- Department of Pediatrics, Luigi Sacco Hospital, Università degli Studi di Milano, Milan, Italy.
| | - Victoria Elisa Rinaldi
- Department of Pediatrics, Università degli Studi di Perugia, Perugia, Italy. .,Department of Pediatric Emergency Care, APHP-Hospital Robert Debré, Paris, France.
| | - Luigi Titomanlio
- Department of Pediatric Emergency Care, APHP-Hospital Robert Debré, Paris, France. .,Pediatric Migraine and Neurovascular Diseases Unit, APHP-Hospital Robert Debré, Paris, France. .,Pediatric Emergency Department, Robert Debré University Hospital, 48, Bld Sérurier, Paris, 75019, France.
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Abstract
OBJECTIVES Infant colic (IC), with an estimated prevalence of 5% to 25%, has a high impact on health care costs. Furthermore, reported negative sequelae are disturbed parent-infant interaction, increased susceptibility to abdominal pain, and even child abuse. Its etiology remains unknown, leading to a wide variety in interventions. We hypothesize that definitions and outcome measures in studies on IC will be heterogeneous as well. Our objective is to systematically assess how definitions and outcome measures are reported in randomized controlled trials (RCTs) of IC. METHODS CENTRAL, Embase, and MEDLINE/PubMed were searched from inception to December 2012. English-language systematic reviews (SRs) and RCTs concerning IC in children ages 0 to 9 months were included. Bibliographies of included SRs were searched for additional articles. Quality was assessed using the Delphi list. RESULTS A total of 1702 studies were found; 55 articles were included (16 SRs, 39 RCTs). In 39 trials, we found 20 different definitions for IC, 11 different definitions for improvement, 28 different interventions, and 19 different outcomes. Fifty-one percent of the trials were of good methodological quality. All of the trials used parental diaries; only 31% stated that their instrument was validated. CONCLUSIONS Too many different definitions and outcome measures for IC are used in RCTs. Only a minority of the trials reported parental perception as primary outcome. Uniform definitions, outcomes, and validated instruments are needed to make a comparison between intervention studies possible.
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Massano D, Julliand S, Kanagarajah L, Gautier M, Vizeneux A, Elmaleh M, Alison M, Lejay E, Romanello S, Teisseyre L, Delanoe C, Titomanlio L. Headache with focal neurologic signs in children at the emergency department. J Pediatr 2014; 165:376-82. [PMID: 24928695 DOI: 10.1016/j.jpeds.2014.04.053] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 03/18/2014] [Accepted: 04/29/2014] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To identify predictors of secondary headache in children consulting at the pediatric emergency department (ED) for headache with a focal neurologic deficit. STUDY DESIGN In this prospective cohort study, we enrolled children aged 6-18 years presenting to the ED of a tertiary care hospital with moderate to severe headache and focal neurologic deficit. Enrollment took place between March 2009 and February 2012. Children with a history of trauma, fever, or neurosurgical intervention were excluded from the study. The final diagnosis was made after 1 year of follow-up. Our primary aim was to identify any differences in the frequency of clinical signs between children with a final diagnosis of primary headache and those with a final diagnosis of secondary headache. RESULTS Of the 101 patients included in the study, 66% received a final diagnosis of primary headache (94% migraine with aura), and 34% received a final diagnosis of secondary headache (76.5% focal epilepsy). On multivariate analysis, children with bilateral localization of pain had a higher likelihood (aOR, 8.6; 95% CI, 3.2-23.2; P<.001) of having secondary headache. CONCLUSION Among children presenting to the ED with focal neurologic deficits, a bilateral headache location was associated with higher odds of having a secondary cause of headache. Additional longitudinal studies are needed to investigate whether our data can aid management in the ED setting.
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Affiliation(s)
- Davide Massano
- Pediatric Emergency Department, Robert Debré Hospital-Assistance Publique Hôpitaux de Paris, Paris Diderot University, Paris, France; Pediatric Migraine and Neurovascular Diseases Clinic, Robert Debré Hospital-Assistance Publique Hôpitaux de Paris, Paris Diderot University, Paris, France
| | - Sebastien Julliand
- Pediatric Emergency Department, Robert Debré Hospital-Assistance Publique Hôpitaux de Paris, Paris Diderot University, Paris, France
| | - Lakshmi Kanagarajah
- Department of Radiology, Basildon University Hospital, Essex, United Kingdom
| | - Maxime Gautier
- Pediatric Migraine and Neurovascular Diseases Clinic, Robert Debré Hospital-Assistance Publique Hôpitaux de Paris, Paris Diderot University, Paris, France
| | - Audrey Vizeneux
- Pediatric Migraine and Neurovascular Diseases Clinic, Robert Debré Hospital-Assistance Publique Hôpitaux de Paris, Paris Diderot University, Paris, France
| | - Monique Elmaleh
- Pediatric Radiology Department, Robert Debré Hospital-Assistance Publique Hôpitaux de Paris, Paris Diderot University, Paris, France
| | - Marianne Alison
- Pediatric Radiology Department, Robert Debré Hospital-Assistance Publique Hôpitaux de Paris, Paris Diderot University, Paris, France
| | - Emilie Lejay
- Pediatric Emergency Department, Robert Debré Hospital-Assistance Publique Hôpitaux de Paris, Paris Diderot University, Paris, France
| | - Silvia Romanello
- Pediatric Migraine and Neurovascular Diseases Clinic, Robert Debré Hospital-Assistance Publique Hôpitaux de Paris, Paris Diderot University, Paris, France
| | - Laurence Teisseyre
- Pediatric Migraine and Neurovascular Diseases Clinic, Robert Debré Hospital-Assistance Publique Hôpitaux de Paris, Paris Diderot University, Paris, France
| | - Catherine Delanoe
- Neurophysiology Unit, Robert Debré Hospital-Assistance Publique Hôpitaux de Paris, Paris Diderot University, Paris, France
| | - Luigi Titomanlio
- Pediatric Emergency Department, Robert Debré Hospital-Assistance Publique Hôpitaux de Paris, Paris Diderot University, Paris, France; Pediatric Migraine and Neurovascular Diseases Clinic, Robert Debré Hospital-Assistance Publique Hôpitaux de Paris, Paris Diderot University, Paris, France.
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Guidetti V, Dosi C, Bruni O. The relationship between sleep and headache in children: implications for treatment. Cephalalgia 2014; 34:767-76. [PMID: 24973419 DOI: 10.1177/0333102414541817] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The existence of a correlation and/or comorbidity between sleep disorders and headache, related to common anatomical structures and neurochemical processes, has important implications for the treatment of both conditions. METHODS The high prevalence of certain sleep disorders in children with migraine and the fact that sleep is disrupted in these patients highlight the importance of a specific therapy targeted to improve both conditions. FINDINGS The treatment of sleep disorders like insomnia, sleep apnea, sleep bruxism and restless legs syndrome, either with behavioral or pharmacological approach, often leads to an improvement of migraine. Drugs like serotoninergic and dopaminergic compounds are commonly used for sleep disorders and for migraine prophylaxis and treatment: Insomnia, sleep-wake transition disorders and migraine have been related to the serotonergic system abnormality; on the other hand prodromal symptoms of migraine (yawning, drowsiness, irritability, mood changes, hyperactivity) support a direct role for the dopaminergic system that is also involved in sleep-related movement disorders. CONCLUSIONS Our review of the literature revealed that, beside pharmacological treatment, child education and lifestyle modification including sleep hygiene could play a significant role in overall success of the treatment. Therefore comorbid sleep conditions should be always screened in children with migraine in order to improve patient management and to choose the most appropriate treatment.
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Affiliation(s)
| | - Claudia Dosi
- Department of Developmental and Social Psychology, Sapienza University, Italy
| | - Oliviero Bruni
- Department of Developmental and Social Psychology, Sapienza University, Italy
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Gelfand AA, Goadsby PJ, Allen IE. The relationship between migraine and infant colic: a systematic review and meta-analysis. Cephalalgia 2014; 35:63-72. [PMID: 24853164 DOI: 10.1177/0333102414534326] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
CONTEXT Infant colic is a common and distressing disorder of early infancy. Its etiology is unknown, making treatment challenging. Several articles have suggested a link to migraine. OBJECTIVE The objective of this article was to perform a systematic review and, if appropriate, a meta-analysis of the studies on the relationship between infant colic and migraine. DATA SOURCES Studies were identified by searching PubMed and ScienceDirect and by hand-searching references and conference proceedings. STUDY SELECTION For the primary analysis, studies specifically designed to measure the association between colic and migraine were included. For the secondary analysis, studies that collected data on colic and migraine but were designed for another primary research question were also included. DATA EXTRACTION Data were abstracted from the original studies, through communication with study authors, or both. Two authors independently abstracted data. MAIN OUTCOMES AND MEASURES The main outcome measure was the association between infant colic and migraine using both a fixed-effects model and a more conservative random-effects model. RESULTS Three studies were included in the primary analysis; the odds ratio for the association between migraine and infant colic was 6.5 (4.6-8.9, p < 0.001) for the fixed-effects model and 5.6 (3.3-9.5, p = 0.004) for the random-effects model. In a sensitivity analysis wherein the study with the largest effect size was removed, the odds ratio was 3.6 (95% CI 1.7-7.6, p = 0.001) for both the fixed-effects model and random-effects model. CONCLUSIONS In this meta-analysis, infant colic was associated with increased odds of migraine. If infant colic is a migrainous disorder, this would have important implications for treatment. The main limitation of this meta-analysis was the relatively small number of studies included.
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Affiliation(s)
- Amy A Gelfand
- Department of Neurology, Division of Child Neurology, University of California, San Francisco (UCSF), CA, USA Department of Neurology, Headache Center, University of California, San Francisco (UCSF), CA, USA
| | - Peter J Goadsby
- Department of Neurology, Headache Center, University of California, San Francisco (UCSF), CA, USA
| | - I Elaine Allen
- Department of Epidemiology and Biostatistics, University of California, San Francisco (UCSF), CA, USA
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Borsook D, Erpelding N, Lebel A, Linnman C, Veggeberg R, Grant PE, Buettner C, Becerra L, Burstein R. Sex and the migraine brain. Neurobiol Dis 2014; 68:200-14. [PMID: 24662368 DOI: 10.1016/j.nbd.2014.03.008] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Revised: 03/05/2014] [Accepted: 03/13/2014] [Indexed: 12/31/2022] Open
Abstract
The brain responds differently to environmental and internal signals that relate to the stage of development of neural systems. While genetic and epigenetic factors contribute to a premorbid state, hormonal fluctuations in women may alter the set point of migraine. The cyclic surges of gonadal hormones may directly alter neuronal, glial and astrocyte function throughout the brain. Estrogen is mainly excitatory and progesterone inhibitory on brain neuronal systems. These changes contribute to the allostatic load of the migraine condition that most notably starts at puberty in girls.
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Affiliation(s)
- D Borsook
- Boston Children's Hospital P.A.I.N. Group, Boston Children's Hospital, USA; Massachusestts General Hospital, Boston Children's Hospital, USA; Harvard Medical School, USA.
| | - N Erpelding
- Boston Children's Hospital P.A.I.N. Group, Boston Children's Hospital, USA; Harvard Medical School, USA
| | - A Lebel
- Boston Children's Hospital P.A.I.N. Group, Boston Children's Hospital, USA; Headache Clinic, Boston Children's Hospital, USA; Harvard Medical School, USA
| | - C Linnman
- Boston Children's Hospital P.A.I.N. Group, Boston Children's Hospital, USA; Massachusestts General Hospital, Boston Children's Hospital, USA; Harvard Medical School, USA
| | - R Veggeberg
- Boston Children's Hospital P.A.I.N. Group, Boston Children's Hospital, USA; Harvard Medical School, USA
| | - P E Grant
- Fetal-Neonatal Neuroimaging and Developmental Science Center (FNNDSC), Boston Children's Hospital, USA; Harvard Medical School, USA
| | - C Buettner
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, USA; Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, USA; Harvard Medical School, USA
| | - L Becerra
- Boston Children's Hospital P.A.I.N. Group, Boston Children's Hospital, USA; Massachusestts General Hospital, Boston Children's Hospital, USA; Harvard Medical School, USA
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Abu-Arafeh I, Howells R. Primary Headaches in Children Under the Age of 7 Years. Curr Pain Headache Rep 2014; 18:401. [DOI: 10.1007/s11916-013-0401-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Abstract
Headache occurring in children under the age of 5 years may cause a high level of anxiety in both parents and medical professionals. Crucial to a consultation about this problem will be to actively seek out clues to sinister pathologies, and investigate or reassure as appropriate. Making a positive diagnosis of a primary headache disorder where one exists is also important; however, in young children, headache does not always conform to well-established diagnostic criteria. This short guide provides a practical overview using the scenario of a new referral to the outpatient clinic.
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Affiliation(s)
- Nadine McCrea
- Department of Paediatric Neurology, Addenbrooke's Hospital, Cambridge, UK.
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Douglas PS, Hill PS. A neurobiological model for cry-fuss problems in the first three to four months of life. Med Hypotheses 2013; 81:816-22. [PMID: 24075595 DOI: 10.1016/j.mehy.2013.09.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 09/03/2013] [Indexed: 01/20/2023]
Abstract
Although problem crying in the first three to four months of life is usually self-limiting, it is not a trivial condition. Early intervention is important, yet families receive conflicting advice from health professionals. The past decade has seen significant advances in neuroscience, lactation science, and developmental psychology, including new insights into the significance of developmentally sensitive windows. We propose a neurobiological model to explain the mechanisms of cry-fuss problems in the first months of life, and the mechanisms which underlie effective intervention, with a view to facilitating research collaboration and consistency of advice across health disciplines. We hypothesise that crying in the first three to four neurodevelopmentally sensitive months signals activation of the hypothalamic-pituitary-adrenal axis and adrenergic neuronal circuitry in response to perceptions of discomfort or threat. Susceptible infants may be conditioned by early stress, for example, by unidentified feeding difficulties, into a sensitised stress response, which usually settles at three to four months of age with neurodevelopmental maturity. Bouts of prolonged and unsoothable crying result from positive feedback loops in the hypothalamic-pituitary-adrenal and adrenergic systems. Importantly, epigenetic modulation of the infant's limbic neuronal circuitry may explain correlations between regulatory problems in the first months of life, and behavioural problems including feeding problems in later childhood.
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Affiliation(s)
- Pamela Sylvia Douglas
- Discipline of General Practice, The University of Queensland, Health Sciences Building, Royal Brisbane and Women's Hospital, Herston 4029, Queensland, Australia.
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Millichap JG. Childhood Migraine and Infantile Colic. Pediatr Neurol Briefs 2013. [DOI: 10.15844/pedneurbriefs-27-5-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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